Why video games can do better than therapy for anxiety and depression

27-06-2017

There are a whole lot of scientifically valid reasons to use video games as engines of emotional change. In clinical, behavioural, and psychological science, Cognitive Behavioral Therapy (CBT) is recognized as the “gold standard” prevention and treatment approach for anxiety and depression. In a nutshell, CBT focuses on changing thinking patterns (e.g., rumination, negative self-talk) and behavioural strategies (e.g., avoidance, withdrawal) that cause and maintain anxious and depressive feelings. Several meta-analyses (a statistical approach that summarizes results of multiple scientific studies) have shown that CBT works, on average, to prevent escalations in anxiety and depression. What’s important to know is that although CBT is currently the most rigorously studied approach, outcomes are mixed and effect sizes are consistently small to moderate. This means that 40–60% of young people who go through CBT in the “real world”(i.e., outside the academic research context) do not improve.

The reinforcing loop between thinking, feeling, doing

Even more disheartening is the fact that our “gold standard” approaches are expensive to deliver (whether in schools or clinics) and often inaccessible to the people who need them most. E-mental health initiatives are skyrocketing as a means of addressing some of the cost and accessibility problems. You can read a summary of the rationale for implementing e-mental health interventions here (2016 article) and here (2017). In sum, they include cost effectiveness, improving access to care, and avoiding the stigma associated with having to seek help. The problem is that e-mental health programs generally don’t work that well unless they’re linked up to a human coach (who keeps people accountable and adhearing strictly to the online protocol). 

Five years ago, I stepped back from the frustration of what seemed like a failure, at least to roughly 50% of the youth on which we were seeking to have an impact. I began to spend evenings exploring the online worlds that young people were engaged with daily. And I discovered the beautiful, emotionally diverse and socially immersive wide world of today’s video games. Today, I am working daily with game designers, artists, and programmers, as well as the young people playing these games, and co-developing emotionally and socially compelling experiences that have the potential to change the way we train emotional resilience in the next generation. We're hoping to use this blog and site to share our design and development process, our data, our games, and the exciting future we're envisioning. 

Why games for mental health?

There are core aesthetic, humanistic reasons I’ve turned to games as potential tools for promoting emotional resilience. But I’m going to save that discussion for another post. Below are six pragmatic, data-driven reasons for the use of video games as intervention tools for mental health.

  1. Engagement: CBT interventions are psychoeducational at their core: they involve a teacher or counselor giving kids lessons on different thinking styles, biases, and so on. There are often workbooks and homework to work through. But adolescents often find didactic lessons boring. Engaging youth in therapy is one of the most challenging tasks clinicians face. In contrast, 97% of youth play video games regularly. We’re using games to hijack this enthusiasm for purposes beyond entertainment, in order to train emotional resilience skills that will prevent anxiety and depression… all while they’re also slaying dragons, socializing with friends, and having fun.
  2. Motivation: The key predictor of treatment outcomes is motivation for change. Adolescents rarely seek professional help on their own but rather feel coerced by external pressures, which curtails efficacy. Conversely, games are intrinsically motivating because they offer a strong sense of agency, opportunities for co-creation with like-minded peers, and, um, yeah… they're fun.
  3. Practice: CBT approaches often do a good job of imparting new knowledge, but they leave a large gap between what an adolescent knows and actually does. CBT tries to address this problem through role-playing and “homework,” but these exercises are time-limited, potentially embarrassing, unconvincing as simulations, and (again) boring. Of course, video games can be played for extensive periods of time without losing players’ interests (much to the chagrin of many a parent challenged with pulling their kid away from said games). They can trigger a range of increasingly negative emotions which, in turn, can motivate players to learn emotion regulation strategies that help them dampen those negative emotions. Loads more to say about why I think games are awesome for creating emotionally authentic training experiences, but for now, suffice it to say that this is a key feature that compels our work. Video games have also become increasingly social in nature, simulating and preparing users for non-digital social challenges that they’ll inevitably face.
  4. Stigma: One of the biggest barriers to prevention and treatment is the stigma associated with mental health challenges. Adolescents are particularly reluctant to ask for help for fear of being labeled by their peers as “crazy” or “weak.” Games have no stigma attached and can be delivered through “stealth” approaches that avoid mental health messaging (a strategy that is difficult to impossible to avoid with current e-mental health approaches).
  5. Personalization: Conventional prevention approaches are unable to tailor interventions to the diverse needs of a vulnerable population. So what you usually get is a one-size-fits-all approach to school programs where all kids are being taught the same skills, presented at the same rate. Video games address this problem elegantly: By design, video games are complex systems that adjust dynamically to the players’ actions. Each player’s in-game progress adjusts the degree of difficulty and reinforcement, maintaining an optimal balance for each individual. Lots of terms for this learning “sweet spot”: in education it’s called the “zone of proximal development,” in the domain of creativity, you often hear reference to “flow.” Game designers have magically held us in that sweet spot for decades.
  6. Access and cost: Approximately 80% of youths who need mental health care receive no services. Those most in need of care have a difficult time accessing programs because of geographical or life-style factors. Cost is also a major barrier to access for a large subpopulation. It goes without saying that the cost of a video game is invariably less than a series of therapy sessions in a mental health clinic or the cost of launching and maintaining such a program in a school system. Games are also easily accessible, online or through stores, and can be used by children, youth and families when they want, in their homes or on their mobile devices.

Further reading:

For further data and details about how other labs are using games, you can check out our review on The Benefits of Playing Video Games, published in the flagship journal of the American Psychological Association. We reviewed the cognitive advantages (by far the most extensive support), as well as the social, emotional and motivational benefits associated with playing video games. Importantly, outcomes of game playing vary hugely depending on the quality and type of games, but outlining what we know, and still need to know, was an important place to start.

*A slightly modified version of this article was originally posted on Medium, by Isabela Granic.

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Isabela Granic

Professor and Chair of the Developmental Psychopathology department in the Behavioural Science Institute; writer; voracious podcast consumer; mother of two upstanding little gamers

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